Why Is Vaping Going Up in Flames?

Abstract

Since their introduction to the United States market in 2007, electronic cigarettes (e-cigarettes) have caused significant controversy among clinicians, the tobacco control community, researchers, smokers and e-cigarette users, and policy makers (1–3). While smokers and e-cigarette users fight for access to these aerosol delivery devices they perceive as safe and healthy, clinicians and researchers urge caution as more and more data demonstrating adverse health effects accumulate. The recent e-cigarette/vaping product use–associated lung injury (EVALI) epidemic highlights the need to better regulate e-cigarette production and sales in the United States. Here we discuss the emergence of vaping devices; the history of e-cigarette regulation (or lack thereof); what is known and unknown about the health effects, including EVALI; and finally what policy changes are desperately needed. E-cigarettes are designed to deliver inhaled nicotine via a process that mimics smoking. E-cigarette users inhale an aerosol commonly referred to as e-cigarette “vapor,” produced by heating a mix of chemicals, called “e-liquid,” in a tank, cartridge, or pod. Each device is slightly different, but in general e-liquid is drawn across a heating element to facilitate the reaction between humectants and water vapor in the air to produce the aerosol. The majority of e-liquids contain a pharmacologically active agent, either nicotine or cannabinoids such as tetrahydrocannabinol (THC), dissolved in a solution composed of propylene glycol, glycerin, and flavoring agents. Many flavoring agents are generally recognized as safe by the U.S. Food and Drug Administration (FDA) and are widely used in the food industry (4); however, this designation is specifically for consumption via the gastrointestinal tract, not via the pulmonary system by inhalation. Furthermore, many of these flavoring chemicals found in e-liquid are known to cause damage to human cells (5, 6), and at least one of them, diacetyl (a chemical that produces a buttery flavor), is known to cause popcorn workers lung (bronchiolitis obliterans) (7, 8).

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